Healthcare Provider Details

I. General information

NPI: 1114807385
Provider Name (Legal Business Name): ROAA OTHMAN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2025
Last Update Date: 09/06/2025
Certification Date: 09/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 GRANT ST
BUFFALO NY
14213-1902
US

IV. Provider business mailing address

25 GRANT ST
BUFFALO NY
14213-1902
US

V. Phone/Fax

Practice location:
  • Phone: 716-235-8675
  • Fax:
Mailing address:
  • Phone: 716-235-8675
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number072999
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: